What is "direct access"?

Healthcare is constantly changing and in most circumstances alterations to the laws cause headaches for consumers and providers as we learn to navigate the new rules and regulations.

Recently, there has been a major push from physical therapists and our professional organization, the American Physical Therapy Association (APTA), to improve direct access to physical therapists. Per the APTA, direct access is defined as

"the removal of the physician referral mandated by state law to access physical therapists' services for evaluation and treatment."

The reasoning behind the direct access initiative, as the APTA aptly states, is that physical therapists are the movement experts who can diagnose and treat movement-related diagnoses and conditions. We are able to screen for diagnoses and conditions that are not within our scope of practice and have the skills to effectively treat patients.

What are the laws in New Hampshire?

The level of direct access to physical therapist services for patients in the United States varies by state. In New Hampshire, we have the status of "Patient Access with Provisions". This is great news! While it is not unrestricted access, this does mean that patients can see a physical therapist without a physician's referral. However, the physical therapist must refer the patient or client to appropriate health care practitioners when:

1. The physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice
2. Physical therapy is contraindicated
3. There is no documented improvement within 25 calendar days of the initiation of treatment.

Should patients have any concerns about direct access?

Patients may be concerned about whether physical therapists are qualified to evaluate and treat without the prior consult or referral of a physician. However, physical therapists now receive a Clinical Doctorate of Physical Therapy (DPT) upon graduation from a nationally-accredited program. This requires extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities.

A physical therapist is considered an entry-level clinician, qualified to recognize when a patient presents with signs and symptoms "inconsistent or outside the scope and expertise of the physical therapist" and require a referral to a physician.

Lastly, liability insurance companies such as HPSO (the leader insurer of physical therapists in the country, does not consider direct access a risk factor during the underwriting of general or professional liability insurance policies.

Direct access positively impact your recovery and healthcare costs

Restrictions that limit early access to physical therapy ultimately result in "higher costs, decreased functional outcomes, and frustration to patients." In a healthcare climate that is putting more and more financial responsibility on the consumer/patient, direct access is a safe and effective method of reducing overall costs and, in some instances, unnecessary imaging. It goes hand in hand with the idea of cash-based or out-of-network providers. It also allows the patient the freedom of choice on who they want as their provider or clinician.

How does this impact your visit with Motus?

I have been treating patients within the state of New Hampshire's direct access laws for many years. I believe the goal of healthcare should be to have timely and effective care, not barriers to access! Patients love the convenience as well as early access to care.

However, it is important to me that the patient has continuity of care. Therefore, while I am not required by law to contact your primary care physician (PCP) unless one of the three restrictions above are met, I choose to keep your physician in the loop at all times. There is nothing more important to me than the highest standard of care for my patients. Patients deserve this quality of care and it helps ensure quick and effective outcomes!

Quick evaluation and early treatment allows my patients to return to the activities they love quicker and with less pain - it's a win-win!

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Cheers!

Kyle